FEVER
- How fever is beneficial?
- Leukocytes show maximum phagocytic activity between 38-40°C
- During fever the circulating iron level goes down. Iron is helpful for the growth and reproduction of bacteria. So, when circulating iron level goes down, bacterial growth is prevented
- Fever produces direct inhibiting effect on certain viruses like polio and coxsackie viruses.
- How fever causes weight reduction?
- ↑ BMR
- ↑ protein breakdown (catabolism)
- Water loss
- Anorexia (loss of appetite)
- Fever blisters (Herpes simplex) seen in
- Pneumonia
- Malaria
- Streptococcal infections
- Meningococcal infections
- Rickettsial fever
Rare in- Typhoid
- TB
- Smallpox
- Mycoplasma pneumoniae
- Beneficial effects of fever
- Neurosyphilis
- Some forms of chronic arthritis
- Gonorrhea
- Malignancy—In fever there is release of endogenous pyrogens which activate T cells and this enhances host defense mechanism.
- Ill effects of fever
- Epileptiform fits
- Weight loss
- Sweating causes salt and water depletion
- Depletion – Dehydration – Delirium
- Fever without infection
- Pontine hemorrhage
- Factitious fever
- Habitual hyperthermia
- Drugs – Atropine, etc.
- Malignancy – Leukemia, Hodgkin, etc.
- Rheumatological disorders, e.g. SLE, rheumatoid arthritis, etc.
- Fever in respiratory system disorders
- Pyogenic infectious of lung – suppurative
- Bronchitis
- Pneumoconiosis
- Pneumonia
- Pleurasy
- Fever in gastrointestinal tract disorders (abdominal)
- TB peritonitis and TB abdomen
- Crohn's disease
- Acute appendicitis
- Subdiaphragmatic abscess
- Perinephric abscess
- Fever in liver disorders
- Infective hepatitis – preicteric stage
- Amoebic liver abscess
- Malignancy
- Cholecystitis
- Fever in hematological disorders
- Hodgkin's disease
- Infections mononucleosis
- Blood transfusion reactions (mismatched)
- Hemorrhage into body cavities
- Septicemic conditions
- Fever in neurological disorder
- Meningitis
- Encephalitis
- Cerebral abscess
- Poliomyelitis – early stage
- Acute polyneuritis
- Head injury
- Pontine hemorrhage
- Cerebral malaria
- Causes of fever with sweating1. Malaria2. TB3. RS: Lung abscessBranchiectasis – acute stagePneumonia4. CVS: Infective endocarditisMyocardial infarctionAterial myxoma5. Renal: Pyelonephritis6. Others: FilariasisAny pyogenic infection
- Special forms of fever
- Charcot's fever
b. Pel-Ebstein fever– Fever lasting for 7–10 days and afebrile for about a week.c. Pretibial fever– Leptospirosisd. Factitious fever– Patient develops fever voluntarily by infecting contaminated materiale. Habitual– Fever with normal sedimentation rate.hyperthermiaUsually occurs in young femalef. Black water fever– Malariag. Black fever– Kala-azarh. Brake bone fever– Dengue- 1°F rise of temperature raises the BMR by 7%
- 1°F rise of temperature ↑ the heart rate by 10 beats
- Heart rate is increased by a maximum of 15 beats per minute during pregnancy.
- Fever in muscle disorders
- Polymyositis
- Born holm disease
- Crush injury to muscles
- Fever in bone and joint involvements
- Osteomyelitis – acute
- Arthritis
- Rheumatoid
- Rheumatic
- Pyogenic
- Malignancy – Osteosarcoma
- Types of fever1. Continuous– Fever is present continuously.Fluctuation of temperature is <1°F2. Remittent– Fever present. Fluctuation >2°F3. Intermittent– Fever present intermittently.
- Causes of remittent fever
- Typhoid
- Infective endocarditis
- Kala-azar
- Plague (Remiteant or continuous)
- Infectious mononucleosis
- TB
- Causes of continuous fever (sustained fever)
- Pneumonia
- Causes of intermittent fever
- Malaria
- Causes of hyperthermia
- Heat stroke
- Hyperthyroidism
- Sepsis
- Pontine hemorrhage
- Anticholinergic drug overdose
HYPOTHERMIA
DELIRIUM
- Causes of delirium
- Fever
- Head injury
- Uremia
- Liver cell failure
- Hypoxia
- Hyponatremia
- Postictal state
- Drugs – Alcohol (withdrawal), Atropine
- Senility
MEDICAL CAUSES OF ITCHING
- Medical causes of itching (pruritus)
- Cholestatic jaundice (more at nights)
- Primary biliary cirrhosis
- Hodgkin's disease
- Uremia – chronic renal failure
- Diabetes mellitus
- Hyperthyroidism and hypothyroidism
- Polycythemia rubra vera – especially after a hot bath
- Advanced stages of pregnancy due to intrahepatic cholestatis
- Sleeping sickness
- Malignancy – leukemia – myloma
- Psychogenic
- Senile pruritus
- Drugs – Aspirin, opium derivatives, quinine, penicillin, sulfa group of drugs
- Onchocercus volvulus
- Carcinoid syndrome
- Iron deficiency
- If there is rubella infection in the antenatal period the child will have:
- Mental deficiency
- Nerve deafness
- Cataract
- Patent ductus arteriosus
- Pulmonary stenosis
- Pulmonary artery branch stenosis
SKIN PIGMENTATION
- Causes of palmar erythema
- Chronic liver disease
- Long standing cases of rheumatoid arthritis
- Thyrotoxicosis
- During pregnancy – disappears after delivery
- Chronic leukemia
- Chronic fever
- Alcoholism
- SLE
- Polycythemia
- Causes of spider naevi
- Liver disorders – Hepatic encephalopathy
- Rheumatoid arthritis
- Pregnancy appears between 2-5th month – disappears after delivery
- Sometimes in normal individuals (Here it is less than 5 in number)
- Causes of flapping tremor
- Hepatic failure
- Chronic renal disease
- Cardiac failure
- Respiratory failure
- Causes of malar flush
- Mitral stenosis
- Lupus erythematosis
- Striae of skin of abdominal wall(Due to rupture of elastic fibers of skin)
- Multiparus women
- In multiparus women if there is sudden↑in abdominal size like
- Abdominal tumor
- Obesity
- Cushing syndrome
- Causes of graying of hair (Loss of formation of melanocytes)
- Aging
- Hereditary
- Albinism
- Pernicious anemia
- Over vitiligo
- Chloroquine toxicity
- Associated with B12 deficiency (Megaloblastic anemias)
Macule:Up to 1 cm, circumscribed flat discoloration not palpablee.g. Flat naeviPetechiaePurpuraDrug eruptionRubella, rubeola, typhoid, rheumatic fever, etc.Papules:Up to 1 cm, circumscribed elevated superficial solid lesione.g. Elevated naeviWartsSecondary syphilisChickenpox, Smallpox, etc.Nodules: Up to 1 cm, may be in level with or above or beneath the skin surface.e.g. XanthomaSecondary syphilisEpitheliomaErythema nodosumVesicles:Up to 1 cm, circumscribed elevated, contain serous fluide.g. Chickenpox – Smallpox – Herpes zosterBullae: Larger than 1 cm. Circumscribed, elevated contain serous fluide.g. Burns and ScaldsPurpuraPetechiaeEcchymosesUp to 2 cm in size1–2 mm size2–5 mm size - Causes of hyperpigmentation of skin
- Scleroderma
- Addison's disease
- Cirrhosis liver
- Hemochromotasis
- Fetty's syndrome
- Pernicious anemia
- Folic acid deficiency
- Malnutrition
- Starvation
- Porphyria lutea
- Drugs:BusulphanArsenical
- Pellagra
- Malignancy (internal)
- Irradiation
- Alkaptonuria
- Arsenic poisoning
- Post dermal kala-azar
- Onchocerca volvulus
- Causes of hypopigmented patches
- Tenia versicolor leprosy
- Vitiligo
- Leprosy
- Causes of ichthyosis
- Lepromatous leprosy
- Hodgkin's disease
- Malabsorption
- Vitamin A deficiency
- Hypothyroid state
- Pellagra
- Refsum's disease – rare
- Congenital
- Some of the autoimmune disorders
- Hashimoto's thyroiditis
- Addison's disease
- Thyrotoxicosis
- Primary atrophic hypothyroidism
- Idiopathic hypoparathyroidism
- Insulin dependent diabetes
- Pernicious anemia
- Rheumatic fever
- Raynaud phenomena seen in (Collagen vascular disorders)
- Scleroderma
- Disseminated lupus erythematosis
- Rheumatoid arthritis
- Dermatomyositis
- Primary pulmonary hypertension (in early stages)
- Myeloma
- Atrial myxoma
- Thoracic outlet syndrome
- Shoulder hand syndrome
- Drugs: Reserpine and methyldopa, guanethidine
- Primary systemic sclerosis
- CREST syndrome
- Polymyosities
- Sjögren's syndromeColor changes – Palar, cyanosis, erythemiaSymptoms are: 1. Numbness,2. Tingling,3. Burning sensation
- Cafe au lait spots seen in
- Multiple neurofibroma
- Albright's syndrome
- Pallor without anemia
- Shock
- Myocardial infarction
- Causes of intermittent jaundice
- Drugs like–Methyldopa, oral contraceptives, salicylates, INH, Chloramphenicol, carbon tetrachloride, trichloroethylene
- Acute intermittent porphyria
- Migrating worms obstructing the ampulla of Vater
- Inflammatory edema of ampulla of Vater
- Gallstones intermittently obstructing the bile duct
- Spasm of bile duct
- Fever like malaria – RBC destruction
- III trimester of pregnancy
- Transient formation in pulmonary thromboembolism
- Lobar pneumonia
- Fear of swallowing (Odynophasia)
- Rabies
- Tetanus
- Hysteria
- Pharyngeal paralysis due to fear of aspiration
- Painful esophagitis
- Causes of erythema nodosum
- Leprosy
- Rheumatic fever
- Tuberculosis
- Sarcoidosis
- Fungal infections
- coccidioidomycosis
- histoplasmosis
- Infection with hemolytic Streptococcus
- Cat scratch fever
- Drugs like – Sulfathiazole
- Diseases spread by dogs
- Rabies
- Hydatid disease
- Tetanus
- Asthma by allergy
- Leptospirosis
- Brucellosis
- Blastomycosis
- Diseases spread by rats
- Plague
- Leptospirosis
- Tetanus
- Asthma by allergy
- Weil's disease
- Diseases spread by laboratory animals
- Asthma
- Toxoplasmosis
- Rabies
- Diseases spread by fish
- Food allergy
- Food poisoning
- Asthma
- Allergic skin lesions
- Diphyllobothrium latum—fish tapeworm
- Diseases spread by pigs
- Cysticercosis – Tapeworm
- Encephalitis
- Brucellosis
- Leptospirosis
- Parasites producing eye lesions
- Toxoplasma
- Onchocercus volvulus
- Loa Loa
- The hormones (only two) which are not controlled by other hormones (Other endocrine glands)
- Parathyroid hormone
- Insulin
- Spider naevi seen in
- Hepatic failure
- Rheumatoid arthritis
- Normally (Particularly in children) – Rare
- Pregnancy (Appear between 2nd and 5th month and disappear within 2 months after delivery)
- NAILS (Transverse ridges)1. Beau's lines→ Trauma, systemic stress2. Terry's nail→ Cirrhosis (Tips-pink proximate white)3. Mee's lines→ Hypoalbuminuria parallel white transverse lines4. Lindsay's nail→ Renal failure, distal red proximal white5. Onycholysis→ Fungal infection/psoriasis/hyperthyroidism6. Spoon nails→ Iron deficiency anemiaLichen planusHypothyroidismSyphilisCoronary arterial diseaseRheumatic fever7. Subungual splinter hemorrhage→ Infective endocarditis8. Clubbing→ Parrot-beak appearance9. Wider nail→ Acromegaly10. Long narrow nail→ Hypopituitarism11. Yellow nail syndrome→ Nail plates yellow12. Hypoplastic nail→ Turner's syndrome13. Eggshell nail→ Syphilis14. Hippocratic nails→Respiratory and circulatory disease/cirrhosis15. Brittle nail (Onychorrhexis)→The free end of nail is laminated and irregular seen inhypocalcemic malnutrition
- Nails
- Rate of growth of nail is 0.5 mm per week (0.1 mm per day)
- Nail growth is faster in summer than in winter
- Nails in hands grow about 4 times faster than nails in toes
- Nails of long fingers grow more rapid than in small fingers
- It is an analog of clear in the lower arrivals
- Causes of Dupuytren's Contracture: (One or both sides may be affected) (palmar fibrosis)
- Alcoholic liver disease
- Trauma
- Epilepsy
- Old age
- Diabetes mellitus
- May be hereditary
- Causes of generalized lymphadenopathy
- Lymphatic leukemia
- Lymphoreticular malignancy
- Secondary syphilis
- Measles
- Infectious mononucleosis
- Sarcoidosis
- Toxoplasmosis
- Causes of unilateral exophthalmos
- Cavernous sinus thrombosis
- Primary tumors within the orbit
- Retro-orbital intracranial tumors
- Diseases of nasal air sinuses (mucococle, carcinoma)
- Arteriovenous aneurysms
- Thyrotoxicosis
- Myxedema
- Polydactyly (supernumerary fingers)
- Koilonychia causes (spoon nails)
- Iron deficiency anemia
- Syphilis
- Lichen planus
- Rheumatic fever
- Hypothyroidism
- Fungal dermatosis
- Hutchinson's triard
- Hutchinson's teeth
- Interstitial keratitis
- Labyrinthine deafness
- Causes of saddle nose
- Syphilis
- Leprosy
- Wegener's granuloma
- Achondroplasia
- Fracture nasal bone
- Hurler's syndrome
- Down syndrome
- S.No.KF ringArcus senilis1.Cornea between ring and limbus is normalCornea seen between ring and limbus2.May be interruptedContinuous3.Golden brown in colorGrayish white4.Seen in the desmous membrane—5.Always pathologicalPhysiological6.Better seen in slit-lamps examinationCan be seen by naked eye
- Causes of pesplanus
- Marfan's syndrome
- Ehlers-Danlos syndrome
- Osteogenesis imperfecta
- Friedreich's foot: High arch foot with hammer toes seen in Friedreich's ataxia.
- Causes of kyphoscoliosis
- Spinocerebellar degeneration – Fredericton's ataxia
- Torsion dystonia
- Marfan's syndrome
- Homocystinuria
- Poliomyelitis
- Syringomyelia
- Progressive spinal vascular atrophy
- TB spine/Tumors of spine
- CV anomaly
- Senile osteoporosis
- Ankylosing spondylitis
- Paget's disease
- Acromegaly
- Rickets
- Exaggerated lumbar lordosis causes
- Muscular dystrophy
- Massive ascites
- Massive abdominal tumors
- Advanced stages of pregnancy
- Pseudomyotonia both contraction and relaxation are delayed but more in relaxation
- Hypothyroidism
- Diabetes mellitus
- Pernicious anemia
- Hypothermia
- Peripheral vascular disease
- Anorexia nervosa
- Ankle edema
- Hammer toes seen in
- Marfan syndrome
- Hereditary motor sensory neuropathy type I
- Friedreich's ataxia
- KF ring seen in
- Wilson's disease
- Primary biliary cirrhosis
- Sclerosing cholangitis
- Vitiligo is seen in the following systemic disorders
- Hashimoto's thyroiditis
- Pernicious anemia
- Addison's disease
- Diabetes mellitus
- Uveitis
- Absent lateral eyebrows
- Hypothyroidism
- SLE
- Iatrogenic
- Drugs
- Causes of central retinal artery occlusion
- Carotid artery emboli
- Giant cell arteritis
- Emboli from heart
- Causes of central retinal vein occlusion
- HBP
- Atherosclerosis
- Hyperviscosity syndrome
- Dysproteinemias
- Blood dyscratic
- Causes of retinal neovascularization
- Diabetes mellitus
- Hemoglobinopathies
- Causes of retinitis pigmentosa
- Refsum's diseases
- Abetalipoproteinemia
- Laurence-Moon-Bardet-Biedl syndrome
- Carotenoderma(Carotene is converted to vitamin A in liver. For this thyroid hormone is necessary)So carotenemia can occur in
- Myxedema
- Liver diseases
- Dupuytren's contracture
- Progressive fibrosis of palmar fascia resulting in painless flexion contracture of fingers.
- Ring finger is first affected and most prominently involved. Then little finger, middle finger, index finger and thumb.
- Puckering of palmar skin is typical.
- Sometimes there may be modulus in the palmar fascia.
- Seen more in B ♂and than in ♀
- Appears after the age of 25 years.
- Seen in liver disease, epilepsy old age, diabetes mellitus.
- Occasionally occurs as familial.
CANCER
- Tumor blush (due to new vessel formation) seen in
- Hepatoma – primary
- Hypernephroma
SMELL
- Fruity or abnormal smell – Diabetic ketosis
- Ammoniacal odor – uremia
- Musty odor (fetor Hepatitis) – liver failure
- Alcoholic smell – Alcoholism
- Halitosis– Bad breath, e.g. starvationGingivitisSuppurative lung disease
- Different odors and diseases1. Halitosis→Suppurative lung disease2. Fruity odor→DKA3. Ammoniacal odor→Renal failure4. Mousy or fishy→Liver cell failureOdor/Feter Hepaticas5. Bitter almond or silver→Cyanide poisoningpolish odor of breath6. Alcoholic odor→Alcohol ingestation
SWEATING
- Pathological causes of sweating
- Pyrexia
- TB – during sleep (evening)
- Pyogenic infection
- Hyperthyroidism ↑ BMR
- Fluid – blood loss shock
- Hypoglycemia
- Psychoneurosis
- Pheochromocytoma
JOINTS
- Charcot joint: Causes
- Tabes dorsalis
- Syringomyelia
- Hereditary sensory neuropathy
- Charcot-Marrie-Tooth disease
- Familial dysautonomia
- Diabetes mellitus
- Leprosy
- Spina bifida
- Prolonged local steroid therapy
- Congenital insensitivity to pain
- Trauma
- Causes of perforation of nasal system
- Syphilis (posterior perforation)
- Lepromatous leprosy
- Intranasal trauma
- Chromium poisoning
- Tuberculosis (anterior perforation)
- Lupus erythematosus
- Workers involved in chrome plating
- Inhalation of dust containing arsenic
- Rheumatoid arthritis
- Wegener's granulomatosis
- Progressive systemic sclerosis (PSS)
- Causes of deformity of skull
- Hydrocephalus
- Oxycephaly
- Paget's diseases
- Apert's syndrome
- Rickets
- Congenital syphilis
- Tumor of skull bones
- Thalassemia major – bossing of skull
- Hurler's syndrome (large and boat-shaped head)
- Causes of alopecia
- Hereditary
- Syphilis
- Diabetes mellitus
- Fungus of scalp and pediculosis
- Pituitary insufficiency Simmonds’ disease
- Irradiation
- Cytotoxic drugs
- Dystrophia myotonia
- Typhoid – rare
- Chemicals; thallium
- Deficiency of zinc
- Werner's syndrome
- Hutchinson's triad (Characteristic of congenital syphilis)
- Hutchinson's teeth
- Interstitial keratitis
- Labyrinthine disease (causing deafness)
- High orched palate
- Marfan syndrome
- Turner syndrome
- Myotonic dystrophy
- Rubinstein Taybi syndrome
- Achondroplasia
- Vincent's angina (Trench mouth)Infection of tonsil and gums usually unilateral causes necrosis with a dirty yellow exudate; when removed causes bleeding. DD– syphilis, diphtheria. Tender painful gingivatis. Bleeding on pressure.
- Ludwig's anginaSwelling of floor of mouth, elevation of tongue, difficulty in swallowing and breathing. Submaxillary space, sublingual space and submental space are involved due to infections.
- Cause of webneck (and low hairline)
- Klippel-Feil syndrome
- Turner syndrome
- Ullrich Noonan syndrome
- Pseudohypoparathyroidism
- Pseudohypoparathyroidism
- Cause of bony (sternal) tenderness (It is a sign of expansion of bone marrow)
- Leukemia's
- Myeloproliferative disorders
- Severe anemia
- Multiple myeloma
- Hodgkin's disease
- Secondaries
- Causes of dwarfism
- Constitutional delay in growth
- Genetic Noonan syndrome – Fanconi syndrome
- Nutritional
- Deficiency intake
- Intestinal malabsorption
- Chronic renal disease – renal rickets
- Chronic infestation
- Protein losing disorders
- Hypoxia
- Congenital cyanotic heart disease
- Chronic pulmonary diseases
- Chromosomal abnormalities
- Down syndrome
- Turner syndrome
- Skeletal disorders
- Achondroplasia
- Hurler's syndrome
- Endocrine disorders
- Hypopituitarism
- Hypothyroidism – cretinism
- Cushing's disease
- Trace elements deficiencyHypogonadal dwarfisms
- Unilateral enlargement of parotids
- Obstruction of parotid duct (stenosis duct)
- Typhoid
- Parotitis
- Leukemia
- Monkey face seen in
- Marasmus
- Hypertrichosis lanugosa (also known as dog face)
- Moon face seen in
- Protein energy malnutrition
- Cushing's syndrome
- Rheumatoid factor will be positive in the following conditions
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Sjögren's syndrome
- Polymyositis
- Scleroderma
- TB
- Leprosy (Lepromatous and Tuberculosis)
- Syphilis
- Infective endocarditis
- Viral hepatitis
- Infectious mononucleosis
- Parasitic infestations
- Pneumoconiosis
- Scleroderma
- Drug abusers
- Chronic active hepatitis
- Cirrhosis liver
- Idiopathic pulmonary fibrosis
- Lymphomas
- Repeated blood transfusion
- Typhoid
- Conditions causing early morning stiffness and pain in joints
- Rheumatoid arthritis
- Ankylosing spondylitis
- Causes of shoulder hand syndrome
- Myocardial infarction
- Trauma
- Hemiplegia
- Degenerative joint disease of cervical spine – cervical spondylitis
LYMPH NODE
- 1. Subcutaneous nodules→ Rheumatic fever2. Osler nodes→ Infective endocarditis3. Rheumatoid nodules→ Rheumatoid arthritis4. Heberden's nodes→ Degenerative jointdisease/Osteoarthritis5. Bouchard's nodes→ Degenerative jointdisease/Osteoarthritis6. Warty nodules on feet and legs→ Pretibial mycoderma7. Painless firm fibrous nodesover bony pronmenus→ Yaws8. Haygarth's nodes: Spindleshaped enlargement of proximalinterphalangeal joints→ Rheumatoid arthritis9. Xanthelasma→ HypercholesterolemiaBrownish yellowAround eyes10. Xanthoma→Also in hands
TESTES
- Causes of primary testicular atrophy: Pituitary function is normal – but testicular function is impaired
- Trauma to testes
- TB infection of testes
- Syphilis
- Gonorrhea
- As a complication orchitis following mumps
- Surgical removal
- Undescended testes
- Irradiation
- Drugs
- Causes of secondary testicular failure
- Pituitary disorders
- Congenital–chromosomal abnormality–Klinefelter syndrome
- Cirrhosis liver (Alcohol)
- Hemochromatosis (By producing cirrhosis)
- Mumps
- Lepromatous leprosy
- Myotonia dystrophia
-
Testicular atrophy (Evidence):
- Small testes (Normal size is 2 × 3 × 4 cm)
- Soft in consistency
- Absence of testicular sensation
ENDOCRINE
- Causes of loss of libido
- Psychogenic
- Cirrhosis liver
- Hemochromatosis
- Dystrophia myotonic
- Causes of gynecomastia
- Cirrhosis liver
- Lepromatous leprosy
- Hemochromatosis
- Myotonic dystrophy
- Klinefelter syndrome
- Estrogen secreting tumors of adrenal gland
- Testicular atrophy
- In males at puberty
- African human trypanosomiasis
- Drugs:
- Estrogen for cancer prostate
- Digitalis
- Spironolactone
- Cimetidine
- Alpha methyldopa
- Reserpine
- Busulfan
- Hepatoma – painful gynecomastia
- Hyperthyroidism
- Leukemia
- Lymphoma
- Bronchogenic carcinoma (adenocarcinoma and large cell carcinoma)
- Prostatic malignancy treatment with estrogen
- Low ceruloplasmin level seen in
- Wilson's disease
- Fulminant hepatic failure
- Severe chronic liver failure
- Protein losing enteropathy
- Malabsorption syndrome
- Causes of ↑serum amylase
- Pancreatitis – Acute stage only
- Perforated peptic ulcer →Peritonitis
- Intestinal obstruction
- Pseudocyst of pancreas (here there is persistant elevation)
- Salivary gland tumors
- Causes of hypocalcemia:
- Hypoparathyroidism
- Malabsorption syndrome
- Osteomalacia due to true vitamin D deficiency or vitamin D resistance
- Renal failure
- Hypoproteinemia
- Pancreatitis – acute stage
- ↑of catecholamines
- Pheochromocytoma
- Hypertension
- Infective polyneuritis
- Hypothyroidism
- Hypoglycemia
- Vigorous physical activity
- Acute myocardial infarction
- Diabetic ketoacidosis
- Depression
- Duodenal ulcer
- Causes of ↑ BMR (Hypermetabolic state)
- Thyrotoxicosis
- Pheochromocytoma
- Fever
- Patients appear older than normal age
- Progeria
- Heavy chronic smoking
- Chronic exposure to sunlight (Rapid skin changes)
- Patients appear young than normal age
- Hypogonadism
- Panhypopituitarism
PAIN
- Causes of headache (Pain and or discomfort from orbit to occiput)
- Meningitis
- Intracranial tumor/abscess
- Migraine
- Subarachnoid hemorrhage
- Temporal arteritis
- Tic douloureux
- Glaucoma/refractive error
- Intracranial AV malformation
- RS causes
- COPD (due to CO2 retention)
- Pneumonia
- CVS causes
- Infective endocarditis
- Pulmonary embolism
- CCF
- Drugs and chemicals
- Oral contraceptives
- Nitrates (Vasodilators)
- CO
- CO2
- EthanolWithdrawal of drugs like
- Ergot
- Amphetamine
- Clonidine
- β-blockers
- Following LP
- Hypoglycemia
- Pseudotumor cerebri
- Premenstrual headache
- Anemia with Hb <10 g%
- Hypertensive if the diastolic BP is more than 110 mm Hg
- Causes of frontal headache
- Sinusitis
- Ocular causes
- Frontal tumor
- Migraine
- Causes of occipital headache
- Meningitis
- Subarachnoid hemorrhage
- Tension headache
- Intracerebral hemorrhage
- Causes of unilateral headache
- Migraine
- Temporal arthritis
- Trigeminal neuralgia
- Causes of burning feet syndrome
- Vitamin deficiency
- Renal failure
- Diabetes mellitus
- Alcoholism
- As a result of toxic, metabolic and inherited disorders
- Causes of shoulder pain (Referred pain)
- Myocardial infarction
- Subdiaphragmatic abscess
- Diaphragmatic pleurisy
- Acute pancreatitis
- Ruptured spleen
- Some cases of appendicitis with peritonitis
- Causes of muscle cramps (painful shortening of muscle associated with palpable knotting)
- Idiopathic (occurs at night at rest)
- During pregnancy
- Unaccustomed exertion
- Diarrhea and severe dehydration (hyponatremia, hypocalcemic, hypomagnesemia)
- McArdle's disease
- Uremia
- Drugs
- Nifedipine
- Nicotinic acid
- Cinetidine
- Morphine
- Diuretics
BLOOD PRESSURE
- Causes of orthostatic hypotension (Postural hypotension) BP ↓ on standing
- Intravascular volume contraction
- Hemorrhage
- Severe chronic anemia
- Sodium depletion
- Pregnancy
- CNS lesions
- CVA
- Trauma
- Infection
- Demyelination
- Spinal cord lesions–syingomyelia/tabes dorsalis
- Pheochromocytoma
- Shy-Drager syndrome
- Aldosteronism
- Drugs – Vasodilators
- Nitroglycerine
- Hydralazine
- Minoxidil
BODY DEVELOPMENT
- Causes of kyphosis
- Senile osteoporosis
- Ankylosing spondylitis
- Paget's disease
- Acromegaly
- Diseases of vertebra – TB vertebra → Gibbus (Pott's disease)
PARASITE
- Parasites producing CVS disorders1. Hydatid→Cyst, CCF, Strokes-Adamssyndrome/conduction disturbances2. Schistosomiasis→Primary pulmonary hypertension3. Filariasis→1. Primary pulmonary hypertension2. Myocarditis4. Trypanosoma cruzi→Myocarditis(Chaga's disease)ArrhythmiasRBBB5. Trypanosomiasis→Myocarditis(Sleeping sickness)Pulmonary edemaCCFPericardial effusion6. Toxoplasmosis→MyocarditisPericarditis/effusionCCFArrhythmiasAdams-Strokes syndrome7. Malarial parasites→AnginaCoronary vascular occlusion8. Leishmaniasis (Kala-azar)→CCF9. Amoebiasis pericardial effusion→Pericarditis, myocarditis,10. Trichinella spiralis→CCF/Arrhythmia
CIGARETTE SMOKING
- Harmful effects of cigarette smoking (Nicotine)CVS: Angina↑platelet adhesiveness atheromatosis plaque Myocardial infarction↑level of carboxyl Hb CAHD/sudden death Coronary arterial spasmRS: Chronic bronchitis, bronchiectasis, pulmonary emphysema Malignancy→Squamous cell and oat cell carcinoma Lungs, oral cavity larynx, esophagus bladder, kidney, pancreas COPDVascular: TAOGIT: Loss of appetiteGastric ulcerDUPancreatic malignancyOthers: Early menopauseSpontaneous abortion in pregnant womenLow birth weight babiesFetal death
- Active ingredient of tobacco is nicotine
- A standard cigarette contains about 20 mg of nicotine
- Smoker inhales about 2 mg of nicotine while smoking one cigarette
- Lethal dose of oral nicotine is 1 mg/kg body weight
- Side effects of oral contraceptives
- Thrombophlebitis
- Thromboembolism – pulmonary
- Hypertension
- Stroke
- Myocardial infarction
- Pulmonary hypertension
- Hypercalcemic states
- Primary hyperparathyroidism
- Milk alkali syndrome
- Hypervitaminosis D
- Sarcoidosis
- Hyperthyroidism
- Cushing's syndrome
- Neoplasm – paraneoplastic syndrome in Coburg's carcinoma
- Multiple mycoma
SKELETON
- Pesplanus seen in
- Ehlers-Danlos syndrome
- Marfan sydrome
- Osteogenesis imperfecta
- Small chin
- Williams’ syndrome
- Turner's syndrome
- Fetal alcohol syndrome
- Teeth abnormalities
- Peg teeth – Hurler's syndrome
- Hutchinson teeth – Peg-shaped notching/incissors
- Malformation of teeth – Williams’ syndrome
- Teeth present at birth – Ellis-van Creveld syndrome
EXAMINATION OF HEAD
- Cause of bruit over the skull
- Carotid cavernous fistula
- AV fistula of cerebral vessels
- Cerebral vascular malformation
- Brain tumor
- Intracranial sacular aneurysms
- Paget's disease of bone
- Angioma of scalp
- Sturge-Weber syndromeIf the carotids are occluded the bruit may be ↓or absent
- Carotid or aortic stenosis
- Young children – not significantBruit is very uncommon over berry aneurysm.Bruit in CNSAuscultation over
- Both temporal bones
- On the lateral occipital region
- Over each closed eye
- Over mastoid abscess and jugular veins
CHEST
- Mantoux will be negative in
- TB abdomen
- Miliary TB
- Extensive advanced PT
- PT with viral infection like chickenpox
- TB patients who are on immunosuppressive drugs
- TB patients on steroid therapy
- With other associated diseases like leukemia, lymphoma, etc.
ALCOHOL
- Diseases in which the symptoms are more after drinking alcohol
- Gout
- Hodgkin's disease
- Acute intermittent prophyria
- Epilepsy
- Pancreatitis
- Migraine
BLOOD
- Causes of bleeding gums
- Leukemia – particularly monocytic type
- Agranulocytosis
- Thrombocytopenic states
- Snake bite – viper
- Vitamin C deficiency
- Hemophilia
- Purpura
- Acute and chronic renal failure
LUNGS
- Chest disorders mimicking abdominal pathology
- Diaphragmatic pleurisy
- Lower lobe pneumonia
- Pericarditis
- Pleural effusion
- Myocardial infarction
- Abdominal causes of tachypnea
- Appendicitis
- Peritonitis
- Intestinal obstruction
- Intra-abdominal hemorrhage
INFECTION
EAR
- Causes of tinnitus
- Mèniére's disease
- Labyrinthritis
- Hypertension
- Acoustic neuroma
- Diabetes mellitus
- Drugs – Aspirin
GAIT
- Conditions where toe walking is not possible
- Parkinsonism
- Sensory ataxia
- Spastic hemiplegia
- Paralysis of soleus or gastric venous
- Cerebellar degeneration
EYE
GASTROINTESTINAL (GI) TRACT
- Fungus affecting esophagus
- Candida albicans
- Aspergillus
- Cryptococcus
- Histoplasma
DIABETES
- Raised glucose tolerance arise (Diabetic) seen in
- Diabetes mellitus
- Atherosclerosis
- Pituitary over activity
- Adrenal over activity
- Liver damage
BIOCHEMISTRY
- ↑levels of serum cholesterol
- Nephrotic syndrome
- Myxedema
- Diabetes mellitus
- Hypercholesterolemia
- Biliary cirrhosis
- Causes of ↑serum alkaline phosphates (Disease of bone, liver and intestine)
- Paget's disease of bone (all disease with extensive involvement of bone producing osteoblastic activity)
- Hereditary hyperphosphatasia
- Liver disorders –Biliary obstructionCirrhosis liverSecondary deposits
- Rickets and osteomalacia
- Fibrous dysplasia (Albright's syndrome)
- Primary hyperparathyroidism
- Metastatic tumor of prone producing osteoblastic activity
- Rarely oral contraceptives by producing liver damage
- Osteogenic sarcoma
- Primary biliary cirrhosis
- Hypernephroma in some cases
- Prostatic carcinoma
- Lymphomas
- Infectious mononucleosis
- Miliary TB
VOMITING
- CVS causes of vomiting
- CCF
- Posterior wall myocardial infarction
- Drugs – Digitalis
- CNS causes of vomiting
- Meningitis
- Encephalitis ↑ICT
- Intracranial tumors
- Hydrocephalus
- Migraine
- Motion sickness
- Labyrinthitis
- Vestibular disorder
- Ménière's diseases
- GIT causes of vomiting
- Acute gastroenteritis
- Appendicitis
- Intestinal obstruction
- Peritonitis
- Biliary colic
- Renal causes of vomiting
- Pyelonephritis
- Ulcerative colitis
- Drugs producing vomiting
- Digoxin
- Respiratory causes of vomiting
- Viral infections
MISCELLANEOUS
- Sudden arrest of breathing during inspiration
- Infection of pleura
- Diaphragmatic pathology – subdiaphragmatic abscess
- Acute cholecystitis – Murphy's sign
- Abdominal anginaIschemia of abdominal viscera due to one or more regional arteries. Trial of symptoms. Postprandial pain, associated weight loss. Diarrhea may be present. Short systolic bruit and in the epigastric or umbilical regions.
- Patients who are not advisable to fly in an aircraft (unpressurised)
- Hemoglobin trait
- Tension pneumothorax
- Tumors (Primary and secondary) seen inPrimary tumorsSecondary tumors seen in1. LungsBrain, bone, liver, adrenal, spinal cord2. LiverBone (ribs, vertebra), brain, lungs3. KidneyLungs, liver, bone, brain4. BonesLungs5. ThyroidSpinal cord6. BreastSpinal cord7. EsophagusLiver, lungs, bones, kidneys, adrenals
- Points to remember
- To produce clinical signs, the GIT bleeding should be minimum of 500 ml of blood.
- To demonstrate shifting dullness in abdomen, a minimum of 500 ml of fluid should be present in peritoneum.
- To demonstrate Puddle's sign a minimum of 120 ml of fluid should be present.
- To appreciate bladder fullness and to initiate micturition minimum of 400 ml of urine should be in the bladder.
- To produce malena, the GIT bleeding must be minimum of 60 ml.
- Earliest anemia is seen in soft palate.
- Earliest jaundice seen in under surface of tongue.
- Earliest RVF – is ↑JVP – last to disappear is also JVP.
- Earliest clubbing seen in index finger.
- Clubbing is seen commonly in those fingers which are used mostly.
- If the secondaries are inLook for primary inBone (Osteolytic changes)Thyroid, kidney, lower bowl, myeloma, carcinoma, breastBone (Osteosclerotic orProstate, Hodgkin's disease,Osteoblastic changes)carcinoid syndromeLungsColon and rectum, GIT, genitourinary system and breast, renal bladder, prostate, ovary, thyroid, pancreas testes, melanoma, lungs, head and neck cancerLiverLung, GIT, breast, thyroid, pancreas, melanomas, prostate, skinBrainBronchus, breast, kidney, thyroid, stomach, prostate, colon, malignant, melanoma, GIT and genitourinary tract, testes, etc.KidneyLungs and liverHeartLungs, breast, malignant, melanoma, Hodgkin's disease, leukemia, GIT, kidneyPericardiumLymphomas, breast, lungs, thyroid, pancreas, melanoma, leukemiasSpinal cordBreast, prostate, lungs, thyroid, uterus, cervix, multiple myeloma, Hodgkin's diseasePleura (with effusion)Lungs, breast, pancreas, stomach, arteries, ovaryCerebellumColon, lungs, breastSkinBreast, prostate, kidney, head and neck, GI tract.
- Causes of preventable blindness
- Vitamin A deficiency
- Toxic amblyopia
- Methyl alcohol
- Nicotine
- Tobacco
- Injury to eye
- Cataract
- Glaucoma
- Trachoma
- Diabetic retinopathy
- Hypertensive retinopathy
- Severe myopia
- Drugs: Steroid11. Infections →Ophthalmia neonatoriumHerpes zoster12. Parasitic →ToxoplasmaOnchocerca volvulusCestodes13. Leprosy →Lagophthalmos – Exposure keratitis
- Medical causes of epistaxis
- Typhoid fever anterior nasal bleed/posterior nasal bleed
- Rheumatic fever
- Pertussis
- Malaria
- Hypertension
- Bleeding diathesis
- Leukemia
- Snake bite – viper
- Scurvy
- Hyperviscosity syndrome
- Weil's disease
- Polycythemia vera
- Osler-Rendu-Weber syndrome
- Lepromatus leprosy
- Aplastic anemia
- Tumors of nose and pharyngeal sinuses
- Sinusitis of ethmoidal sinuses
- Drugs–Aspirin, Indomethacin, etc.–NSAID and anticoagulants
- Acute and chronic renal failure
- Causes of impaired immunological defenses (Immunosuppressive conditions)
- High dose steroids
- Lymphoreticular malignancy
- Sickle cell disease
- Alcohol abuse (ethanol)
- Splenectomy
- Examination of conjunctiva
- 1. Anemia
- 2. Jaundice
- 3. Bitot's spot
- 4. Telangiectases→ Ataxia telangiectasia5. Conjunctival suffusion→ Leptospirosis6. Subconjunctival hemorrhage→ # face, bleeding disorders7. Conjunctival ulcer→ Behçet's syndrome8. Blue sclera→ Marfan syndromeOsteogenesis imperfecta
- Xerostomia (Dry mouth) seen in
- SLE
- Rheumatoid arthritis
- Scleroderma
- Sjögren syndrome
- Polyneuritis
- Drugs like atropine
- CarotinodermaCarotene is converted into vitamin A in the liver with the assistance of thyroid hormone. So carotinoderma occurs in hepatic disease myxedema (It is yellow color of skin due to carotene) (better seen in palm and sole).
- Criteria for sudden death
- Natural death occurring within one hour of onset of symptoms
- May or may not be pre-existing disease
- Time and mode of death is unexpected. It should be:
- Natural
- Unexpected
- Rapid
- Nonmedicolegal death
- Causes of sudden death
- Myocardial infarction
- MVPS
- Athletes after severe exercise
- Heavy cigarette smoking
- Cardiomyopathy – HOCM dilated
- Cardiac rupture – Rupture of ventricular aneurysm
- Cardiac injuries
- Tumors of heart – sarcoma
- Myocarditis
- Pulmonary hypertension (Primary and Secondary)
- Pulmonary thromboembolism
- Aortic stenosis
- Arrhythmias
- Hair
- The lifespan of length hair varies from 4 months (in eyelashes and axilla) to 4 years in scalps.
- The rate of growth of hair is about 1.5 to 2.2 mm per week.
- Graying of hair is due to loss of melanin pigment due to reduction in the number of functioning melanocytes.
- ErythromelalgiaNo definite cause. Painful extremities often exposed to heat.The extremities are red and warm to touch. Seen in:
- Rheumatoid arthritis
- SLE
- Diabetes mellitus
- Hypertension
This should be differentiated from painful cold exteriorities mainly seen in:- Ischemic disease
- Neurological disorders like painful neuropathy
- Local pathology